Emergency Medicine- UVA Medical Center
The notice flashes in red on the electronic board in the Emergency Room. Everyone within eyeshot becomes quiet and reads the board: Alpha Trauma- ETA 5 minutes. Alpha Trauma. This is bad. Gunshot wound, stabbing, car crash, cardiac arrest…anything where the patient is near death, has lost massive amounts of blood, and has a rhythm requiring CPR. This time, the board reads 26 year old female, self- inflicted gunshot wound. The trauma team, nurses, physician attendants, EMS staff, and pharmacists rush in the trauma room to take their place and prep for the patient. The pharmacist grabs medication for a possible rapid sequence intubation and the code trays. The other Emergency staff take their places around the trauma bed waiting for the EMTs to bring the patient in. The chief trauma resident stands in front of everyone and calls out tasks to each person in the room. Everyone gets quiet and patiently waits. The EMT crew finally arrives with the patient on a stretcher and with everyone’s help, gently and swiftly get her on the trauma bed. The team works quickly to cut her clothes off and get pads on her for monitoring while the EMT crew yells out all the information he has on the patient and how she was treated en route. It’s a horrific scene. She has a hole in her chest and is still losing blood rapidly. After they remove her bloody clothing, and are able to get access to the wound site, the team looks for an exit wound to control the bleeding. The exit wound is in the back of her head. A minute later, her blood pressure starts to drop rapidly. The trauma chief yells to the pharmacist to start getting medications from the code cart…
This was my first day at the University of Virginia Medical Center. I had been there for 15 minutes and was getting a tour and information about the rotation from my preceptor when I got my first trauma. My preceptor looked at me said, “put your stuff down, we’ll finish up later, you’re getting your first trauma experience right now”. I was nervous and excited. My preceptor told me before I got in the trauma room, that if I felt uncomfortable or if anything that I saw was too much for me, I could walk out. I knew I wanted to see everything and experience what a pharmacist does during a trauma or code. Even though it was a shocking and terrible scene, I wasn’t leaving the room. They prioritize their trauma patients as Alpha(highest level), Beta, and Gamma. Today we had an Alpha.
UVA medical center is a level 1 trauma center in Charlottesville, VA. It’s a 600 bed hospital located in the heart of the University of Virginia. It’s one of the big 3 trauma centers in Virginia, next to Carilion Hospital and VCU. I chose to come here because I was very interested in Emergency Medicine and the role pharmacists have. Due to UVA being a teaching hospital, the ER is filled with residents and students, from the Medical and Nursing School, and EMT training. I didn’t realize how much the pharmacist is relied upon in the Emergency room. The attending doctors and residents will come to the pharmacist’s office, located in the ER, and ask for advice on antibiotics, pain medications, proper sedatives, and hypertensive medications in emergencies. They play a big role in working alongside the physicians, not only in codes, but sick visits, from the flu, pneumonia, heart failure exacerbations, to drug overdoses and smaller traumas. There’s also a Pediatric Emergency Room attached to the main ER, which the pharmacist helps with sedation procedures and recommending proper antibiotics. I particularly loved this rotation, because as soon as we had a patient to see and assess their chief complaint, my preceptor would ask me what I thought was going on and to make the recommended therapy. After talking it over with me, I would go and speak with the physicians or residents, and make my recommendations along with my reasoning. I also learned how to prime IV lines and set up IV pumps to start running antibiotics or IV fluids. Whenever a patient needed to have a CT or CTA done, I would travel with the Emergency team to the CT room. I was able to see first hand signs of cerebral infarcts and hemorrhaging on a patient.
I would recommend this rotation if you’re interested in another side of pharmacy, that treats patients acutely, and you want a busy and fast paced atmosphere. In the ER, you’re exposed to a variety of patient conditions that don’t always have textbook answers, so you’ll learn ways to treat patients and be able to take that with you as you work in other areas of the hospital. The preceptors are great and will make sure you have an on-hands experience.
